8^th International Conference on Stroke and Cerebrovascular Diseases July 29-30, 2019 Park Inn by Radison Stockholm Hammarby Sjostad, Midskeppsgatan 6 SE-120 66 Stockholm, Sweden

Biography:

Abstract:

Background and Purpose—Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk.

Methods—In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs).

Results—In the ARIC study 10362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (χ2 trend P<0.0001); the incidence rate for ischemic stroke/1000-person years was 1.29 for PPC-A (health), 2.82 for PPC-B, 4.80 for PPC-C, 3.81 for PPC-D, 3.50 for PPC-E, 4.78 for PPC-F, and 5.03 for PPC-G (severe periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95% confidence interval, 1.2–5.6) and thrombotic (hazard ratio, 2.2; 95% confidence interval, 1.3–3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95% confidence interval, 0.63–0.94).

Conclusions—We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke.

Biography:

Dr. Sarkis Morales Vidal is a neurologist in Broadview, Illinois. He received his medical degree from Universidad Central del Este Facultad de Medicina and has been in practice between 11-20 years.

Abstract:

Purpose of Review Fat embolism syndrome (FES) is a rare disorder with potentially devastating neurologic complications. This article reviews the history, pathophysiology, clinical features, diagnosis, and treatment of FES with a focus on its neurologic aspects. Recent Findings The neurologic complications of FES are more commonly recognized with current diagnostic testing and increase awareness of the disorder. FES may present initially with neurologic manifestations. Prompt diagnosis of FES and of its neurologic manifestations could be lifesaving. This includes respiratory support and management of neurological complications. Summary The classic clinical triad of pulmonary insufficiency, neurologic disturbances, and petechial skin rash typically presents 24 to 72 h following an initial insult, most commonly a traumatic long bone fracture. Early onset (< 24 h) and delayed onset (> 72 h) have been described. Neurologic manifestations may include ischemic/hemorrhagic strokes, retinal ischemia, seizures, autonomic dysfunction, and diffuse brain injury. Diagnosis remains clinical. Management consists mainly of supportive care

Biography:

Tomoya Kamide has completed his MD at the age of 25 years and PhD at the age of 32 years from Kanazawa University. He is the assistannt professor of Neurosurgery, department of cerebrovascular surgery, international medical center, Saitama Medical University. He has published more than 10 papers in reputed journals.   

Abstract:

Objective: The aim of the study was to better define the incidence of and risk factors for early seizures after repair of unruptured intracranial aneurysms in modern microsurgical techniques.

Patients and Methods: The medical records of 414 consecutive patients who underwent neck clipping of unruptured intracranial aneurysms in our institution over a 5-year period were retrospectively reviewed. Clinical and neuroimaging variables were analyzed to investigate putative predictors of perioperative seizures using multivariate logistic regression analysis.

Results: Overall, 24 patients (5.8%) developed seizures within 14 days of surgery without routine prophylactic use of anticonvulsants. Eleven patients experienced partial seizures, while 13 experienced secondary generalized seizures. The interval between surgery and seizure onset was less than 6 hours in 8 patients, 6–24 hours in 3, and 1–14 days in 11. History of dialysis (odds ratio [OR] = 77.6, 95% confidence interval [CI] 7.5–1783.4, P < 0.001), and presence of cerebral contusion (OR = 5.1, 95% CI 1.3–16.9, P = 0.02) or infarction (OR = 13.9, 95% CI 3.9–48.5, P < 0.001) detected by postoperative computed tomography were independent and significant risk factors. No patients with early seizures went on to develop refractory epilepsy.

Conclusions: Dialysis and iatrogenic brain damage were associated with a higher risk of early seizures after aneurysm surgery. Our data support the selective use of anticonvulsants during the perioperative period of elective aneurysm surgery.

Biography:

Junior Clinical Fellow, Stockport NHS Foundation Trust, UK

Abstract:

Introduction: Reperfusion therapy with Alteplase has made a dramatic change in the management of acute ischemic stroke. Bleeding is one of the major complications of this therapy. Despite exclusion criteria, patients still bleed as a complication of this medication. Despite clearly agreed guidelines, clinical practice seems to differ widely amongst various practitioners. Several areas of concern identified and attempted to be addressed in the last audit since 2017. Loop closure audit undertaken to assess change in practice to enhance patient care and safety.

Aim: The Loop Closure audit was to establish improvement on areas of previous underperformances, especially sub-optimal BP monitoring and to look additionally at other potential factors that might have contributed to recent concerns on increased incidence of bleed after thrombolysis

Result: Post Thrombolysis BP Management is far from satisfactory with major deficit in standard. Hourly BP monitoring rate has been improved although BP measurement every 15 minutes post thrombolysis period has deteriorated from 85% to 60% . The rate of inappropriate referrals has dropped from 65% to 37%. More than 50% who bled did not have appropriate blood tests done (previously 60%). 60% of thrombolysed patients had NIHSS between 7—16 which shows the trend to have remained unchanged and which is also in keeping with national recommendation. 50% bled between 6-24 hours (previous 30%) and 27% bled after more than 24 hours (previous 55%). Death rate remains high in Post Thrombolysis bleed, around 40%. The mortality rate remains persistently higher.

Biography:

Angie Logan is a Clinical Specialist Physiotherapist in Stroke and Neurology and a Clinical Doctoral Research Fellow funded by the National Institute for Health Research (NIHR). She is leading her research across Cornwall and Devon in South West England and continues to work clinically with patients in West Cornwall.

Abstract:

People with severe stroke experience significant muscle weakness which means that they spend much of their time in bed or sitting. This inactivity can cause their muscles to become even weaker and stiffer and may lead them to experience sudden drops in blood pressure when they move from lying to standing (orthostatic hypotension (OH)). This further interferes with their ability to participate in intensive stroke rehabilitation, overall recovery and quality of life. Currently physiotherapy for people with severe stroke concentrates on practising tasks such as getting in and out of bed into a chair that are important for independence and achieving safe discharge home. Standing up early after a stroke may help strengthen muscles, reduce OH and minimise or prevent muscles becoming stiff and weaker. This trial aims to assess whether it is possible for people with severe stroke to use a standing frame to practise functional movements such as standing and moving between sitting and standing during their hospital-based rehabilitation. Fifty people with a severe stroke will be recruited from four different Stroke Rehabilitation Units in Cornwall and Devon. Using a computer programme, participants will be randomly allocated to either (1) functional standing frame programme (30 minutes) and 15 minutes of usual physiotherapy, or (2) 45 minutes of usual physiotherapy only. They will have one physiotherapy session per day, with a target of a minimum of five times per week for three weeks

Biography:

Hiroki Kobayashi has completed his MD at the age of 25 years from Kagoshima University. He is the assistant professor of Neurosurgery, department of cerebrovascular surgery, international medical center, Saitama Medical University

Abstract:

Background: Aneurysms of the distal anterior cerebral artery (ACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated.

Objective: To clarify the clinical features and treatment outcome of ruptured distal ACA aneurysms treated at our institute.

Methods: Between 2012 and 2018, a total of 37 consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms underwent surgical clipping or coil embolization at our institute. Clinical presentations, radiographic findings, and outcomes were reviewed retrospectively. Additionally, we analyzed risk factors of poor outcome (mRS 4-6) using multiple regression analysis.

Results: Nineteen patients (51.4%) were W.F.N.S grade IV-V, and frontal lobe hematomas occurred in 18 patients (48.7%). Five patients (13.5%) and thirteen patients (35.1%) manifested azygous or bihemispheric ACA and multiple aneurysms, respectively. Surgical clipping and endovascular coiling were performed in 28 patients (75.7%) and in 9 patients (24.3%) respectively, and aneurysms located at the A4-5 portions were mainly treated by surgical clipping (p=0.04). There were no statistical differences in procedure-related morbidity and mortality between those groups, but complete occlusion rate was higher in the surgical group (p<0.01). Favorable neurological outcome at discharge (mRS 0-3) was obtained in 23 patients (62.5%), and multiple regression analysis revealed W.F.N.S grade IV-V and frontal lobe hematomas were risk factors of poor outcome.

Conclusion: Our treatment result using surgical clipping and endovascular coiling was acceptable and poor W.F.N.S grade and frontal lobe hematoma were risk factors of poor prognosis.

Biography:

Tori Hysko is a current second year student at the University of Central Florida Medical School, hoping match into a neurology residency. Prior, she completed her Masters in biomedical science at the University of South Florida and her undergraduate degree, with a major in neuroscience, at Wellesley College

Abstract:

Alteplase is a tissue plasminogen activator (tPA) that has been shown to be the most accessible and effective medical treatment for ischemic stroke with Class I level A evidence in favor of its use.1 However, its use in treatment of mild stroke remains controversial. We hypothesize that patients in the Orlando Health stoke database with a low NIHSS score (National Institutes of Health Stroke Scale; NIHSS < 5), who otherwise meet criteria, are not always treated with Alteplase.2,3 Our goal is to examine the variability of physician treatment and outcomes in mild stroke patients and to better understand why all physicians are not using tPA to treat mild stroke patients, despite its proven effectiveness4,5,7. We speculate the wide variability in treatment of mild strokes is due to the conflicting data seen in the stroke literature, ambiguity of the clinical guidelines, lack of understanding of the risk vs. benefit ratio in this population.6 If our hypothesis is correct, our results will help to educate the Orlando Health medical community on how to more effectively treat mild stroke patients. Our results will help guide future research efforts to revamp current stroke guidelines, which could ultimately improve patient’s functional outcomes and decrease the healthcare cost of mild strokes nationwide.

Biography:

Segundo Mesa Castillo. As Specialist in Neurology, he worked for 10 years in the Institute of Neurology of Havana, Cuba.  He has worked in Electron Microscopic Studies on Schizophrenia for 32 years. He was awarded with the International Price of the Stanley Foundation Award Program and for the Professional Committee to work as a fellowship position in the Laboratory of the Central Nervous System Studies, National Institute of Neurological Diseases and Stroke under Dr. Joseph Gibbs for a period of 6 months, National Institute of Health, Bethesda, Maryland, Washington D.C. USA, June 5, 1990. At present he is member of the Scientific Board of the Psychiatric Hospital of Havana and give lectures to residents in psychiatry.

Abstract:

There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus [1]. The current available technology doesn't allow observing what is happening at cellular level since the human brain is not exposed  to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations [2]. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of the gametes or the amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.

1.            Yolken RH, Torrey EF. Viruses, schizophrenia and bipolar disorders. Clin Microbiol Rev 1995; 8: 131-145.

2.            Mesa CS. An ultrastructural study of the temporal lobe and peripheral blood in schizophrenic patients. Rev Neurol 2001; 33: 619-623.

Biography:

Dr. Tammi McGill-Carter Neurodevelopmental Specialist Gary and a Master’s of Arts Chicago School of professional Psychology Merrillville Indiana, USA

Abstract:

Long term use of first-generation Anti-psychotics (FGAs) have been theorized in the formation of motion disorders Tardive Dyskinesia and Akathasia and due to the breakdown in the Extra Pyramidal System (EPS) located in the Basal Ganglia (Lehne, 2013). The Second-generation Anti-psychotics (SGAs) were sourced to be the “treatment” of TD by blocking dopamine receptors with dopamine agonists of the D2-D5 receptors while also being seen as the genesis of AK. However, the blocking of the receptors in both motion disorders is a theory known as the dopamine blockage theory, despite the intermingle of other neurotransmitters such as Serotonin and Norepinephrine

Biography:

Assitant Professor  in Mazandaran University of Medical Sciences, Iran 

Abstract:

Introduction: Selenium is a trace element essential to human health, that protect against cellular damage by oxygen radicals through selenoproteins. Ischemic stroke is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Supplementing stroke patients with antioxidant nutrients may improve survival.

Method: This was a randomized, double-blind ,placebo controlled  study on consecutive ischemic stroke patients admitted in Buali sina Hospital, Sari, Iran, during 2015-2017. Inclusion criteria was accepted ischemic stroke by brain CT or MRI during last 72 with  volume of at list one third of MCA territory. The patients were randomized into two therapeutic groups, one receiving Vial selenium 2000 microgram stat and 1000 microgram daily for 5 days  and the other 40 cc normal saline stat and 20 cc daily for 5 days. Primary outcome measures with  National Institutes of Health Stroke Scale(NIHSS) and modified Rankin Scale (MRS). Secondary Outcome Measures with Barthel index 3 months after discharge.

Results: 40 ischemic stroke patients(18 females, 22 males) with mean age of 68.2 ± 10 years were investigated. Differences in NIHSS and Barthel index  were not significant between the two groups; but differences in mRS  was significant in case group(p<0.00).

Conclusion: Selenium can improve short term ischemic stroke outcome, but it not influence the long term outcome.

Biography:

Victor Manolov has completed his PhD at Medical University in Sofia, Bulgaria. He is working as Assist. Prof. at Department of Clinical laboratory and clinical immunology at the same University. His interests are in neurology, pediatrics, gynecology, endocrinology and clinical laboratory. He has published more than 20 papers in reputed journals

Abstract:

Obstructive sleep apnea syndrome (OSA) is defined as a combination of symptoms as a result of intermittent, recurrent constraint and / or complete airway overhead airway overflow (sleep disturbance). OSA is associated with the development of insulin resistance, arterial hypertension, metabolic syndrome, systemic atherosclerosis and increased cardiovascular risk. 49 patients with OSA were included; age 44.1 ± 7.7. Their results were compared to sex and age matched healthy control. CBC, serum iron, ferritin, hsCRP, hepcidin, homocysteine and vitamin B12 were measured in the included groups. IMT and FMT were used for atherosclerotic changes evaluation. We found increased serum hepcidin levels in OSA patients with IMT and FMD changes (129.9 ± 20.4 μg/L) compared to control group  (20.9 ± 1.7 μg/L); P<0.001. A positive correlation was found in OSA patients with atherosclerotic changes between IMT and FMD to serum hepcidin levels (r=0.811, r=0.829, resp.; P<0.005). Serum hepcidin correlates positively to homocysteine and vitamin B12 in OSA patients (r=0.809, r=0.855, resp.; P<0.01). Brain-vascular disease risk factors are connected to obstructive sleep apnea syndrome. Disregulation of iron homeostasis is one of the main risk atherogenesis factors. Early hepcidin quantification might predict an atherosclerosis occurrence in OSA patients, which might be very important for better clinical diagnosis and practice.

Acknowledgements: This project is sponsored by MU-Sofia, as part of Grant Д-52/2018.

Biography:

Consultants, Poland

Abstract:

Case report: A 61-year-old female patient after ischemic stroke with left-sided paresis and neuropsychological disorders. Rehabilitation was carried out in accordance with the ICD-9 procedures over 3 weeks with additional sessions with a neuropsychologist, occupational therapist and speech therapist. The subjective and objective condition of the patient partially improved and the program was recommended to be continued at home.

Discussion: Stroke causes cognitive disorders, including those affecting higher cortical functions. Their etiopathogenesis and the resulting problems hindering the rehabilitation program are presented.

Conclusions: Cognitive and emotional disorders which restrict functioning and rehabilitation processes are found in the patient. Neuropsychological therapy was an essential part of the treatment, which was helpful in the improvement the patient’s quality of life.